Prejudice can have benefits

Tuesday

Nov 30, 2010 at 12:01 AMNov 30, 2010 at 12:07 PM

By RANDY COHEN

My same-sex partner and I are legally married in another country, a marriage not recognized by our state or (obviously) federal government, with significant negative consequences to our modest financial situation. My partner would be eligible for some government aid if she applied as a single person, but it feels disingenuous to do so because as a family, we make well above the poverty line. In some sense, however, the government owes us this money because it unjustly disregards our marriage. Should she apply?

— Name withheld, Portland, Maine

There’s no ethical obstacle to her doing so. As you realize to your dismay, in this context “single” is a technical term with a precise meaning defined by law. Your partner’s duty is to meet the criteria for aid and fill out those applications honestly. If, for the purposes of, for example, health insurance subsidies, the agency administering the program regards her as single, she has every right — ethical and legal — to apply as such.

“Family” has various meanings to a religious body, to a state legislature, to a boss who hopes his employees won’t unionize, to Don Corleone. I take it to be a synonym for “insipid” when it precedes the word “film” and for “inedible” when followed by the word “restaurant.” Context shapes meaning. What’s more, marriage has long been, among other things, an economic institution. Your partner may take that into account when considering these applications.

This decision has nothing to do with the government’s compensating her for rough treatment or being evenhanded or mitigating any injustice marriage law imposes on you both. Nor could you argue that because federal marriage law discriminates against same-sex couples, denying them equal treatment, you have an ethical right to balance the scales by cutting the line at the post office or punching a homophobe in the snoot, however appealing those actions might seem. But you have no duty to set stricter standards for such programs than the law itself. Similarly, although I favor a more progressive income tax, one that might compel a nice fellow such as me to write a bigger check, I am not morally obliged to send the Internal Revenue Service more money than current law prescribes.

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I am a psychiatrist who happens to be an atheist. Occasionally a patient asks me what religion I follow and, displeased by my answer, seeks another psychiatrist. I am a physician, not a priest. Religious beliefs seem as relevant to my profession as they are to an accountant’s. Nevertheless, candor sometimes costs me a patient. May I claim a belief in God to avoid damage to my credibility and business?

— Vaidyanath Iyer, The Woodlands, Texas

To rephrase your question slightly: May you lie to a patient to initiate a relationship of trust? OK, I’ve rephrased it totally and unflatteringly, but the answer — no — is provided by the American Psychiatric Association’s “Principles of Medical Ethics,” which requires you to be “honest in all professional interactions.” And rightly so.

What you may do is decline to answer such questions. Glen Gabbard, a professor of psychiatry at Baylor College of Medicine, told me in an e-mail that “it is not dishonest to use restraint in responding to questions of a personal nature.” He added, “One can also inquire about the reasons for the question.” The patient’s reply might offer insights useful in treatment.

The patient’s question need not reflect mere prejudice but could express a desire for a psychiatrist whose personal experience will yield a deeper understanding of the patient. On such benign grounds, some women seek a female psychiatrist, some homosexuals a homosexual. But it also is true that you need not be a Presbyterian to effectively treat a Presbyterian. Even a gay female Presbyterian.

And so you should respond courteously to such queries, answering those about your training and technique but not those you deem irrelevant to the work.

Are you Jewish? A Republican? An opera buff? This demurral could cost you a patient or two, but so be it. A patient’s determination to make an unwise decision does not justify a doctor’s deceit.